Hannah Hood and her children, Montana, 6, and Joseph, 3, don't have insurance. She opposes the provisions of the Affordable Care Act that will require most people to have insurance.

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Photo illustration by Dean Curtis/News-Leader

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Jordan Valley Community Health Center plans to have three full-time employees help people enroll in health insurance. Megan Rowe, a spokeswoman for the center, said the nonprofit will target people in households with income less than 200 percent of the federal poverty level. Efforts will focus on patients at Jordan Valley who are currently uninsured — about 10,000 people. Jordan Valley, a nonprofit, provides care to uninsured patients and people on Medicaid and receives federal funding.

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Stay-at-home mother Hannah Hood and her family are the type of people federal lawmakers had in mind when they approved the Affordable Care Act, which is bringing sweeping changes to what insurance will cover and how people will pay for it.

Hood said she and her two young children, ages 6 and 3, don’t have insurance. Her husband, Bryan, has insurance through his job, but Hood said the premiums are too high to add the rest of the family.

But Hood, whose younger brother is conservative state lawmaker Elijah Haahr, wants no part of the changes coming Jan. 1, the date most people will be required to have health insurance.

“I don’t like it,” said Hood, who was watching her children play recently at Grant Beach Park. “I don’t think we should be told to get it. We can’t afford it ... I feel it’s just another way the government is taking away our freedom.”

Widespread opposition in southwest Missouri and little information about what’s available are just some of the obstacles that proponents of the health care law will face as some of the most important provisions of the new law are phased in.

Enrollment for health insurance in the new exchanges where people can shop online for insurance starts Oct. 1. The prices for policies in Missouri haven’t been released, leaving consumers in the dark.

Missouri won’t set up its own exchange, nor will the state enforce what are known as “market reform” provisions for private insurers, such as a ban on insurers denying coverage to applicants. Voters in November barred Gov. Jay Nixon from setting up an exchange in Missouri without legislative or voter approval.

That means people who don’t have insurance or people who want to shop on the exchanges for a better deal will have to use an exchange that the federal government is setting up at https://www.healthcare.gov.

“Delaying the release of premium information limits the amount of time individuals and families have to plan and budget for the substantially higher insurance costs many will face,” Blunt wrote to Sebelius in an Aug. 12 letter.

Regarding costs, however, a report released in July by the U.S. Department of Health and Human Services examined prices in the 11 states where the figures were available. That report found that the prices it examined were, on average, 18 percent lower than predicted.

U.S. Sen. Claire McCaskill said people want affordable insurance.

“The focus should be on making people understand how they should access the rates,” McCaskill said.

U.S. Rep. Billy Long said he continues to believe that the health care law should be repealed.

“We need a health care system that drives down the cost of care and incentivizes investment in new technology to increase the quality of care,” Long said.

“The free market is the only system that has proven time and again to achieve the best outcome for the most people.”

The Missouri Hospital Association has set up a website, Enrollmissouri.org, with information for individuals, businesses and health care providers. People can’t enroll for insurance on that site.

Dave Dillon, a spokesman for the hospital association, said the MHA set up the website in part because of the lack of information from public sources.

“It is trying to fill the gap that exists,” Dillon said.

He said the biggest challenges people will face in trying to decide where to buy insurance will probably be coverage and cost.

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“It is always a balance between the two issues,” he said.

Missouri’s inaction on enforcement means that federal regulators will be in charge of making sure insurance companies in Missouri follow these new regulations, known as the 2014 market reforms. These include prohibiting insurance companies from denying coverage because of pre-existing conditions and requiring insurers to cover at least 60 percent of total costs in each plan.

“We are enforcing because Missouri notified ... that it has not enacted legislation to enforce and that it is not otherwise enforcing the Affordable Care Act market reform provisions,” Gary Cohen, the director of the federal Center for Consumer Information and Insurance Oversight, wrote to the Missouri Department of Insurance in March.

Some observers say this could mean Missouri could face a bumpier road in enforcing the provisions than states that are enforcing the new regulations themselves.

“It could be difficult for federal officials who aren’t on the ground,” said Katie Keith, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms in Washington, D.C. “Since the rules are totally new, you don’t know what games are going to be played. You want somebody watching the henhouse closely.”

Tim Jost, a law professor at Washington and Lee University in Virginia, said Missouri could have more problems enforcing the new provisions but only marginally. He questioned what would happen if an insurance company continues to deny coverage for pre-existing conditions.

“Does this mean the insurance commissioner has to ignore it and leave it up to the federal government to enforce it?” Jost asked. “That’s kind of crazy.”

Missouri has historically had weak oversight of insurance companies. Federal regulators have more power. Under the Public Health Service Act, federal regulators can impose fines of up to $100 a day for each individual affected by an insurance company that is violating the law.

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Chris Cline, a spokesman for Missouri’s Department of Insurance, said consumers should contact the department with questions or complaints about their insurance policy or company. The consumer hotline is at 800-726-7390.

“If it’s not an issue the department can assist with, we will direct the inquiry to the appropriate agency,” Cline said.

Hood said she and her husband rarely go to a doctor. The children have a pediatrician, and the family pays cash for their doctor appointments. The family’s annual income of $24,000 means their children could qualify for Medicaid, but Hood hasn’t enrolled them. The last time Hood saw the doctor was at her six-week checkup after the birth of her youngest.

Hood and her husband might have qualified for Medicaid if state lawmakers, including her brother, had supported the expansion pushed by Nixon. Their income means they won’t face financial penalties if she doesn’t get insurance.